Plasma renalase as a biomarker of acute kidney injury after cardiac surgery

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Ihab A Ibrahim, Hossam A Sayed, Amal A MohammedDOI:10.4103/1110-7782.200966

Background
Renal ischemia/reperfusion injury is a major cause of acute renal failure. The lack of validated early biomarkers for predicting acute kidney injury (AKI) has hampered our ability to initiate potentially preventive and therapeutic measures in an opportune way. We tested the hypothesis that plasma renalase is an early biomarker for ischemic renal injury after cardiac surgery.
Patients and methods
We prospectively evaluated 40 adult patients who underwent cardiac surgery. Patients were divided into the AKI group and the non-AKI group on the basis of whether they developed postoperative AKI within 48 h after surgery. Plasma renalase levels were measured before surgery and 24 h after surgery. The primary outcome was AKI diagnosed using the Acute Kidney Injury Network criteria.
Results
Twenty-five (62.5%) patients developed AKI after surgery. Plasma renalase decreased significantly from a mean of 1.2±0.46 ng/ml at baseline to 0.9±0.42 ng/ml 24 h after cardiopulmonary bypass, with a mean %change of 27±14.8 in the AKI group. Univariate analysis showed a significant correlation between AKI and the following: %change in plasma renalase, cardiopulmonary bypass time, and aortic cross-clamp time. Receiver operating characteristic curve analysis revealed that for %change in plasma renalase concentrations at 24 h, the area under the curve was 0 · 9, sensitivity was 0.92, specificity was 0 · 87, and likelihood ratio was 7.07 for a cutoff value of 9% change.
Conclusion
Plasma renalase %change is more valid compared with renalase before or after procedure and neutrophil gelatinase-associated lipocalin in the prediction of AKI and represents a novel and highly predictive early biomarker for AKI after cardiac surgery.

Background
Chronic kidney disease (CKD) is a progressive loss in renal function over a period of months or years. In the metabolic association of an elevated circulating chemerin level in the context of uremia demonstrate that high chemerin levels predict a better survival in CKD patients. The aim of the study was to measure serum chemerin and to correlate it with other parameters in CKD patients.
Patients and methods
This study was conducted on 40 patients with CKD, including 20 patients with end-stage renal disease under regular hemodialysis and 20 patients with renal impairment on conservative therapy who have not started hemodialysis, and 22 apparently healthy participants serving as the control group. Human chemerin is determined by sandwich enzyme immunoassay.
Results
There is a highly statistically significant difference in mean serum chemerin and mean serum high-sensitivity C-reactive protein (hs-CRP) in the patient groups in comparison with the control group. In addition, there was a highly statistically significant difference between control group, under hemodialysis group, and renal impairment group as regards serum chemerin and serum hs-CRP. A positive correlation between serum chemerin and hs-CRP studied in the under hemodialysis group, renal impairment group, and in all patients’ group.
Conclusion
A significantly higher chemerin level in patients with impaired kidney function compared with the normal control group, and a high increase in patients under hemodialysis compared with the other two groups.

Background
Colonoscopy is a technically demanding procedure with the potential to cause harm if its performance is suboptimal. It is incumbent on endoscopists, therefore, to evaluate their practices and to make improvements wherever possible. Bolak Eldakror Hospital is a secondary-care governmental hospital in Egypt in which we set up an endoscopy quality-assurance program in 2003.
Aim
The aim of this study was specifically to evaluate the quality of colonoscopy practice in our endoscopy unit and by publishing our experience to encourage others to develop a quality-improvement program.
Patients and methods
Predetermined international quality indicators for colonoscopy were employed to monitor the standard of endoscopic procedures between 2010 and 2014. Recorded information included all medical and technical details.
Results
A total of 286 colonoscopies were assessed. The main indication of colonoscopy was hematochezia (58.7%). Polyps were the main endoscopic findings (34.6%). Conscious sedation was used in 56.6%. Cecal intubation was achieved in 77.6%. The adjusted cecal intubation was 94%. Image documentation of cecal intubation was achieved in 92.3% examinations reaching the cecum. Mean cecal intubation time was 17.4±10 min. Mean withdrawal time was 6.6±4 min. The main reasons for unsuccessful cecal intubation were impassable mass or stricture in 23 (8%) colonoscopies and poor bowel preparation in 23 (8%). Colon preparation was rated adequate in 66.4%. Diagnostic colorectal biopsies for those with persistent diarrhea were obtained in 97%. Polyp detection rate was 36.1% and adenoma detection rate was 5.3%. Polypectomy was carried out in 89 (93.6%) patients with detected polyp/s. Retrieval of all excised polyps was successful in 84.3%. Postpolypectomy perforation occurred in one (0.4%) patient.
Conclusion
A high standard of colonoscopy can be achieved by the rigorous application of quality-assurance measures.

Background
Worldwide, the population treated with renal replacement therapy is increasing, representing ∼1.3 million patients who undergo dialysis and 400 000 patients who are alive with a kidney transplant. Transplantation is more predictable than it was 20–30 years ago and innovation over the last 20 years has been rapid, delivering substantial short-term and medium-term improvements. Many reports have been published about the epidemiology of renal transplantation in different countries. The aim of this study was to identify the epidemiology of renal transplantation in Cairo University hospitals.
Patients and methods
This is a retrospective study that was conducted at the King Fahd Unit, Faculty of Medicine, Cairo University, on 282 patients. All patients were followed up for a period of at least 1 year. Demographic data, history taking, clinical examination, immunosuppressive medications protocol, and laboratory investigations were recorded for every patient.
Results
Of the 282 patients included in the study, 68.1% of recipients were male and 31.9% were female, whereas 52.5% of donors were male and 47.5% were female. An overall 98.6% of our patients received living kidney transplants, whereas 1.4% received cadaveric kidney transplants. The most common cause of end-stage renal disease was unknown etiology. The mean BMI increased significantly after transplantation to reach 22.6±4.0 (P=0.0001). Hypertension was the most common disease among the patients; 82.2% of our patients were already hypertensive before transplantation.
Conclusion
The majority of our recipients were male patients in their second and third decades of life, Moreover, the majority of donors were also male individuals in their second and third decades of life. Most of the transplants carried out by us are living-donor procedures.

Background
Acute liver damage may be followed by biochemical, behavioral, and pathological alterations, which can end up in serious complications and even death.
Aim
The aim of this study was to determine whether quercetin, a flavonoid compound, which is also known to have cell-protective, antioxidant, and anti-inflammatory effects, has any protective impacts against thioacetamide (TAA)-induced liver damage in rats.
Methods
Thirty-six Sprague–Dawley rats were divided into three groups: group C1, normal rats; group C2, rats that received a single dose of TAA (350 mg/kg) intraperitoneally; and group E, rats that received a single dose of TAA (350 mg/kg)+300 mg/kg quercetin intraperitoneally. At the end, liver enzymes and plasma ammonia (NH4) were measured, and pathological analysis of the liver carried out.
Results
The measured serological markers except for total bilirubin (alanine aminotransferase, aspartate aminotransferase, and NH4) showed a significant decrease in group E compared with group C2. The quercetin-treated group showed a significantly lower clinical grade of encephalopathy. Pathological findings showed a significantly lower piecemeal necrosis in group E compared with group C2. Moreover, there was a nonsignificant decrease in focal necrosis, apoptosis, and focal inflammation in group E compared with group C2. Portal inflammation scores were lower in group E than in group C2. Therefore, quercetin significantly affected the grade of liver damage, as group E had lower grades compared with group C2 (P<0.05).
Conclusion
Overall, quercetin showed positive effects on both the liver injury and its related behavioral and biochemical changes.

The bicuspid aortic valve is associated with disorders of the aortic wall, including coarctation of the aorta and aortic dissection. The histologic abnormality underlying aortic complications in bicuspid aortic valve is cystic medial necrosis. The elastic properties of the aorta are abnormal in bicuspid aortic valve. Here, we present a case of aortic thrombotic occlusion in a patient with a bicuspid aortic valve.